An Innovative GP-Physiotherapist Partnership on Outcomes for Chronic Obstructive Pulmonary Disease (COPD)

All participants will attend an initial one hour face-to-face appointment within the GP practice with the respiratory physiotherapist. In this appointment, all patients will undergo pre and post bronchodilator spirometry testing based on the American Thoracic Society/European Respiratory Society (ATS/ERS) lung function guidelines. The physiotherapist will then determine the level of obstruction for those with existing COPD or determine whether the patient has a diagnosis of COPD which will be based on post-bronchodilator results of a forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) of <0.7. All patients (new cases and existing COPD) will also be required to complete a number of disease-specific and activity related questionnaires. Patients will be included for follow up testing in the study based on a COPD diagnosis from spirometry testing determined by the physiotherapist. If obstruction is confirmed, participants will be required to attend two further face-to-face appointments with the physiotherapist at one month and at three months which will go for approximately 45 minutes duration each. If spirometry appears abnormal for other reasons, the results will be discussed with the GP and where appropriate, patients will be referred for further testing with respiratory specialists. Intervention will include; Arm 1: Newly diagnosed COPD (administered by the physiotherapist): a) referral to GP for review and medications as well as commencement of GP management plan/team care arrangement at the baseline assessment for participant to attend within one month of referral. The physiotherapist will determine if the participant has attended this appointment by either patient self-report at the one month assessment or by audit of GP records b) physical activity advice, exercise prescription and provision of a pedometer to monitor physical activity goals. The physiotherapist will provide physical activity advice using the 5As approach. The 5As (Ask, Advise, Agree, Assist, Arrange) are a clinical tool recommended for health behaviour counselling in primary care which will enable the physiotherapist to determine where the participant is currently at, identify barriers to engaging in regular physical activity as well as strategies to overcome these barriers and tailor physical activity goals towards the participant. Examples of exercise prescription that the physiotherapist may encourage include forms of aerobic exercise such as walking, cycling and swimming and upper and lower limb resistance exercises such as squats, step ups and light dumbbell exercises. Participants will be given a handout of the exercises as well as a pedometer diary to monitor daily step count. c) referral to pulmonary rehabilitation (PR) if meets the COPD-X Guidelines criteria for referral which state that all patients with COPD (of all dyspnoea grades) will benefit from PR and recommend that all patients with exertional dyspnoea, those at risk of exacerbation and following an exacerbation should be referred to PR d) patient education and booklet from the Lung Foundation Australia e) a written Lung Foundation Australia COPD action plan f) smoking cessation advice and referral if necessary. A brief discussion and intervention will be provided to all smokers at the time of initial assessment and if necessary, at follow-up appointments informed by the The Royal Australian College of General Practitioners (RACGP) guidelines including readiness to change, identification of barriers to quitting, referral to quitline and referral to GP for pharmacological support Arm 2: Patients with existing COPD (administered by the physiotherapist): a) referral to GP for review/commencement of GP management plan/team care arrangement at the baseline assessment for participant to attend within one month of referral b) physical activity advice using the 5 A’s approach, exercise prescription and pedometer to monitor physical activity goals c) referral to PR if meets requirement d) patient education and booklet from the Lung Foundation Australia e) a written Lung Foundation Australia COPD action plan f) smoking cessation advice and referral if necessary Arm 3: Those without COPD on spirometry (administered by the physiotherapist): a) physical activity advice using the 5 A’s approach and exercise prescription b) smoking cessation advice and referral to the GP if necessary